Public Speaking Anxiety & Fear of Being Noticeably Nervous: Mind Surgery for High Performers
SEASON
1
EPISODE
15

High Performance Use of Beta Blockers

This episode examines the use of beta blockers for social and performance anxiety, including the risks of psychological dependence. It explains how occasional strategic use may complement treatment while overreliance can interfere with learning to accept, experience, and ultimately control the body’s natural adrenaline response.
Episode Overview

What This Episode Is About

“Steve,” who had experienced social and performance anxiety since childhood, discusses the productive—and potentially counterproductive—use of beta blockers in treating public speaking anxiety. His symptoms included anticipatory worry about presentations, monologues, introductions, and other situations in which attention might be focused on him. By his forties, some of these situations had developed into intense phobic reactions and panic. The discussion examines how beta blockers can reduce the physical effects of adrenaline and may be useful strategically in certain high-risk performance situations. However, psychological dependence on medication can also prevent a person from learning to tolerate and ultimately control the sensations they fear. The treatment philosophy discussed in this episode emphasizes that adrenaline must be experienced in order to learn how to manage it. Steve describes integrating medication into a broader treatment process rather than allowing it to become a permanent avoidance mechanism, while developing greater confidence in his own ability to handle performance anxiety.
At a Glance

This podcast is best for:

CEOs, executives, clinicians, attorneys, students and performers whose careers depend on speaking — and who have found that competence alone did not resolve the fear.

Episode Details:

16
 min, 
28
 sec
February 10, 2025
Full Transcript

This episode's transcript:

[00:00:00]
Thank you for joining us Steve. I have a question for you as you were anticipating this discussion. Did you feel any adrenaline? Yes, yes, I did. I certainly did. One to 10. I would say more on a level of two to three. Just want to make sure I’m prepared and ready to go. Okay, positive anticipation. So, let’s frame this discussion for the listeners. Give a little bit, explain a little bit about your history with social anxiety. You’ve had it for how long and what has it looked like. Well, I believe I may have had it my entire life, but I know for sure when I was 12 years old, I had a situation where I was nervous in front of people and you know, I’m now in my early 50s.
[00:00:59]
I’ve had it at least in 12 years old and at age 44, I had a panic attack where I would worry about certain things. If I had to do a monologue, speak to a presentation, something as simple as introducing myself would get me very nervous. It was as if I would take the situation and turn it into a phobia, worrying about things for days, even weeks at that. So, I had those things going on, but I also would sometimes watch certain situations where I just didn’t feel comfortable. So, describe a typical scenario back before you started working with me and what would happen. You would have a speaking engagement and you would start worrying and then what would take place.
[00:01:55]
Well, let me say this. I have done hundreds of presentations in school, college, et cetera, business world. A lot of times, if I do, I prepared an advance. I would do a great job. Feedback was very positive, but there were certain instances, for example, if I had to go into a scenario where I might have to introduce myself in front of a group and give a one to two minutes monologue about myself, for some reason that would make me very, very nervous. So, in those situations, I would worry about those potential scenarios, days or weeks in advance. To the point where it just was overwhelming and I knew that I needed to seek help for this issue.
[00:02:52]
For the sake of relativity and in working with me, you know that I like to measure everything on the one to ten skills. So, if ten is the most severe and one is the least, grading your problem and the more that people listen to these interviews that I do, the more they understand their layers to the problem. There’s the anticipatory worry. There’s the anxiety in the challenge scenario itself. There’s the fear of the physical symptoms. There’s the ruminating afterwards. There’s how it impacts the mood in general and self-esteem. If you started at what number with severity, you’re at what number right now? Well, I would say right now I’m at a one or a two. I’m feeling much better about myself where before in first situation it was a minor attempt.
[00:03:49]
Okay, well, I’d like you to share with the audience how you achieve this. When I look at my records, I see that over the course of one year, approximately, you had 21 sessions with me. That’s a lucky number by the way. So, share with the listeners what you did to achieve your success. Well, first of all, I’m sure I’m glad when I searched for you. I found your information online and I was able to start meeting with you. But I learned that I’m not the only person with social anxiety. There are a lot of people that have social anxiety. So, really understanding I’m not the only person in understanding more about the underlying issues of social anxiety and learning about the whole issue, I think, is the plot. The book that you have, work makes me nervous, excellent. Reading that book, taking notes, going through the exercise in the book, all health. And I think finally, utilization of the beta blockers in certain situations for me really helps. The beta blockers would make my heart rate relax and just made me feel at ease when I would go into a situation that I felt could be tense. I think the other plus to the beta blockers is that now if I have an upcoming event, I’m not so worried. I’m not worried about it. Not nearly the way I watched the past, well, I know that if I need to use beta
[00:05:35]
blockers, occasionally, for certain scenarios that have made me nervous in the past, I will do still have a healthy. Okay, well, the title of this interview is High Performance Use of Beta Blockers. So, I want to nail down your high performance use because the last thing that I would want is somebody who has public speaking anxiety thinking, okay, I’m just going to take a beta block and my problem is going to be over. For example, I remember one woman who was in management and she was going to Toastmasters and when she, which I refer a lot of people to, by the way, and when she went to Toastmasters, she took a beta block and my response to that was, what are you doing? Toastmasters is a place where you experiment and you invest in learning skills. So, clarify when you make the decision and how you make the decision to use the medicine.
[00:06:35]
Well, it’s truly a matter of certain situations where I feel that it will help me, it will make me more relaxed and I’m not saying all public speaking scenarios. If I have to give a speech that’s too late, there’s a good chance that I’m not going to use beta blockers because I know that I can give great, because I’ve gone to Toastmasters and helped me. But there are certain situations where if I might be in a group and I need to do a monologue presentation of myself that’s not prepared in advance, those types of things that pass have, I feel like there’s no couple of phobia over them. So, those situations would use the beta blocker and just one of them, just one and it is really healthy to be more relaxed and at ease.
[00:07:34]
Okay, well, let’s back up for a minute here. The way that I understand it, correct me if I’m wrong, is that you use a beta, and you’re busy, you’re an executive and you do a lot of interaction and you have a lot of meetings and you’re a busy guy. And the way that I understand it is that you use a beta blocker approximately once every how often. Once a month. Okay. And what I tell my patients regarding beta blockers is if you use it when needed here and there, it’s really okay, healthy and productive. You just don’t want to get into a habit where you’re dependent on it and you use it in all situations. So, talk a little bit about what you learned to control your social anxiety in general so that basically it’s only about three, four, five percent of the time that you do take a beta blocker. Give a little more insight, like for example, when we used to have our sessions, you used to talk about one three five. Can you share what that is?
[00:08:49]
Yeah, really, the one three five is the high state frame of mind and utilizing adult logic and having a positive frame of mind. Also, natural child being able to mix them, humor, sometimes certain marios. I think humor is a good thing to do. And then the third one, the nurturing current, being able to logically think through things and talk them through utilizing that with adult logic and basically having a positive frame of mind and rationally talking through things and trying to have a good balanced approach to the five mind states making sure that the two negative mind states are not too high in respect to form.
[00:09:58]
Okay, well, when you’re talking about the negative mind states, just to clarify, all the states are very important. The mind states and their specific energy with each one, what Steve is referencing is that the excessive critical mind state and how that hooks the excessive adaptation or the adaptive child mind state. So basically though, I’m thinking that you learned the treatment and your reading and the self-help to accomplish the vast majority of your success through natural methods, but you save the beta blocker. And this is the point that I want to make sure I’m right about and the point that the audience gets that you save the beta blocker for the overwhelming specific once a month type of challenge. Is that accurate? It is definitely every public presentation, speech, etc. I would use a beta blocker. No, of course, specific situations where I feel it will help me and become more relaxed, but it’s certainly not a scenario where I would want to use it every time. No, okay, but those specific scenarios where you take the beta blocker are characterized by what elements, because I’m thinking that it’s the real overwhelming challenges that result in you taking the beta blocker and knowing that you have that as a tool has taken away a lot of the obsessive worry, but that it’s a small percentage of the time that you utilize them.
[00:11:42]
Yeah, exactly. And I use it where scenarios in the past perhaps I had a bad situation, a social situation, or a certain type of public presentation, a certain type of audience. I think social anxiety can be very specific from person to person. One person may have a fear, another person may not have a fear. So in a certain specific situation where perhaps I feel I will have a rapid heartbeat and become very nervous, that would be a scenario where I would use a beta blocker. But in other scenarios, for example, if I have to give a speech, even the board of directors, and I’m all butts up and I have a far-point conversation, I would not need a beta blocker. I would have confidence that I could stand up there, give a great speech. But there are other times scenarios where I just don’t have that confidence, and beta blockers have worked. Okay, what is the pattern? I know I’m busting you, Champsia, but what is the pattern of the challenge? What are the specific variables that determine when you’re going to take the beta blocker? Because you give plenty of speeches, you have plenty of interactions. What is it about the peak challenge? What are the variables about the peak challenge that require you to want to have that safety valve?
[00:13:16]
Well, I think one area is more off-cost, type of communication in front of an audience, where perhaps I don’t have a what-up for considered presentation, the more of a monologue communication that I might have to do in a group. So, last question here. So, after having struggling with social anxiety for such a long time, for many decades, and now you have it, you’re saying 95% on the control. What has your life different? Or, just, last worry on my mind, which is wonderful, if there’s an event that’s coming up, I’m not obsessively worried about it for days, for weeks, even months. So, piece of my more just relaxful attitude positive frame of mind. Yeah, so that’s all great. This has been wonderful. I just thank you, Jonathan, that I was able to find you and meet with you. But, my advice to people out there would be to feel they have those playing anxiety. Number one, take health. Look for health. Try to understand the situation, which is point two. The more you can learn about social anxiety, I think the better off you will be. And number three, don’t give up. This is certainly not an easy process. I don’t think I’ll ever feel 100% of the time. But, it’s something where you can definitely become much better and have less anxiety in your life. So, good thing. Well, I thank you very much for sharing.
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Meet the Speaker

Jonathan Berent, LCSW

Psychotherapist & Author — Social Anxiety and Performance Anxiety

Jonathan Berent, L.C.S.W., A.C.S.W., is a psychotherapist who has been practicing since 1978. He has created the Berent Treatment Method for Social Anxiety, which is the result of his clinical work with thousands of individuals of all ages with social anxiety since 1978. He has extensive clinical experience with avoidance and dependance personality disorder, and is the author of Work Makes Me Nervous: Overcome Anxiety and Build the Confidence to Succeed (Wiley, 2010), Beyond Shyness: How to Conquer Social Anxieties (Simon & Schuster, 1992), and Social Anxiety: The Untold Story, which is a training course for mental health professionals in using the Berent Method to treat social anxiety. (Andrew Kukes Foundation, 2011).
SocialAnxiety.com, has served millions of unique visitors as a multimedia clearinghouse for patients, parents, and fellow mental health professionals in search of articles, educational materials, and books on social anxiety and related subjects. His library of clinical interviews appears to be the most documented clinical success with social anxiety.

Guest Speaker

Frequently Asked Questions

Common Questions About Social Anxiety Treatment

Beta blockers are sometimes prescribed to reduce physical effects of adrenaline, such as rapid heart rate or trembling, during performance situations. They may reduce certain physical symptoms, but they do not address the underlying thoughts, emotions, avoidance patterns, or fear of anxiety itself. There is a right and wrong way to use beta blockers. While they can be quite effective, they inhibit one’s ability to learn the skill of “surfing” which is based on adrenaline-energy acceptance! Medication decisions should always be discussed with a qualified medical professional.

High-performance use of medication for public speaking requires effective diagnostics and treatment protocol. When used productively pharmacology is a great tool. When used inappropriately it will breed over-dependence!

Adrenaline is part of the body’s normal response to a perceived challenge or threat. It can increase heart rate, alertness, energy, perspiration, and other physical sensations. The goal is not to eliminate adrenaline, which would be an unrealistic expectation. Learning how to experience, regulate, and channel that energy without interpreting it as dangerous is critical for resolving performance anxiety. The adrenaline control technique is “surfing” which is based on the paradox of adrenaline acceptance.

Because it takes a lot of misplaced energy. Trying desperately to conceal anxiety requires constant self-monitoring. Instead of focusing on the conversation, audience, or message, attention becomes focused inward: “Am I blushing? Is my voice shaking? Can they see me sweating?” This heightened monitoring can increase anxiety and make normal physiological sensations seem more threatening.

The right therapy can. This requires a methodology that integrates FATE. F=(function) physiology A = (action) behavior T = (thinking) cognition. E = Emotion

Take the Next Step

You Do Not Have to Manage This Alone

Public speaking anxiety, performance anxiety, and social anxiety respond to treatment. If this episode described your experience, a conversation is the great next step.